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Medical Edge Newspaper Column from Mayo Clinic

LONG WAIT LIKELY FOR KIDNEY-PANCREAS TRANSPLANT

DEAR MAYO CLINIC: My husband just completed his testing to qualify for a kidney-pancreas transplant. He is 41 years old and has been diabetic since 1987. He went on dialysis in April of 2004. We were told that if he does not receive a transplant, his life expectancy is two to five years. How is it decided if a person receives a transplant or not, and if he’s rejected, can the decision be appealed? — Florida

ANSWER: The transplantation evaluation and selection process varies from place to place. Someone who is turned down by one program may be accepted by another.

In general, a transplant candidate must be able to take many medications and go to regular doctor visits after the transplant. He or she must be free of infection and cancer, and heart problems must be corrected to the extent possible prior to transplantation. In essence, a qualifying transplant candidate must be in “good enough” health to survive the operation and to thrive following it. A person who cannot meet these requirements will not have a successful transplant.

Even if the patient meets all of these requirements, he or she may have to wait three to five years for a kidney or kidney-pancreas transplant from a deceased donor. And many people will not survive long enough to receive a transplant.

A 41-year old man with diabetes has an average life expectancy of about five years with dialysis, and 18 years with a kidney or kidney-pancreas transplant. Despite the superior survival and a better quality of life with a transplant, only about 5 percent of dialysis patients will receive a transplant this year in the United States. The reason: There are very few organs available for transplantation.

A living donor kidney transplant is an option we encourage. The kidney donor must have normal kidneys and be free of medical problems that can cause kidney failure. A donor cannot have heart disease, cancer or infections (such as HIV) that could be transmitted to the transplant recipient. Finally, most programs require a recipient and living donor to have compatible blood types, although Mayo Clinic has medical options to overcome this barrier for many donor-recipient pairs.
One option for your husband to consider is having a living-donor kidney transplant now — if a living donor is available — and a deceased-donor pancreas transplant later. While your husband’s situation is a difficult one, there are options, and you should explore them all with your medical team.

— John Dillon, M.D., Nephrology, Mayo Clinic, Rochester, Minn.

Additional Resources:
Transplant Center
Organ Donation
More Information on Organ Transplants

DEAR MAYO CLINIC: For a long time after the birth of my child two years ago, I had no desire for sex. Now my desire is back, but the experience isn’t the same. I feel much less nerve sensation during intercourse. Is this a result of giving birth? I’ve heard there are surgeries to tighten up the vagina. Do I have any options?

ANSWER: After the birth of a baby, it is not at all unusual to be less interested in sex. This is probably caused by multiple factors, not the least of which is the lack of sleep that occurs with an infant in the house.

Another reason is that, after deliver, the ovaries aren’t producing the hormones that often help spark interest in sex. Breast-feeding prolongs the suppression of ovarian function. The suppression of ovarian function also leads to dryness and lack of lubrication in the vagina. This problem can make intercourse uncomfortable and that can further suppress desire.

So, your initial lack of interest in sex, and eventual recovery, is just what we’d expect.

However, it is not likely that the delivery itself is the explanation for a lack of sensation. Only very rarely is obstetrical trauma responsible for a lack of sensation in the vulva and vagina.

In answer to your question about a surgical snugging procedure to “tighten up” the vagina, this would only be recommended if the childbirth had caused a great deal of stretching of the birth canal.

I recommend that you see your doctor to assess this problem.

— Roger Harms, M.D., Obstetrics and Gynecology, Mayo Clinic, Rochester, Minn.

Additional Resources:
Gynecology
Appointment Information
More Information on Sexual Function

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Medical Edge from Mayo Clinic is an educational resource and doesn’t replace regular medical care. To e-mail a question, go to www.mayoclinic.org, or write: Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave., Suite 114, Buffalo, N.Y., 14207. For health information, visit www.mayoclinic.com.